Provider Demographics
NPI:1851923668
Name:ORTIZ, LUIS ENRIQUE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:ENRIQUE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1484 AVE. F. D. ROOSEVELT
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-783-4510
Mailing Address - Fax:787-792-0831
Practice Address - Street 1:1484 AVE. F. D. ROOSEVELT
Practice Address - Street 2:SUITE 19
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-783-4510
Practice Address - Fax:787-792-0831
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32611835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care